Saturday, August 29, 2009

As a rule, politicians are a skittish and mercurial bunch, though I'm pretty sure many of them aren't necessarily born that way. Seriously, how many of these guys woke up one morning as a bright-eyed Poli-Sci undergrad at The University of Tennessee or Northwestern - or wherever - and declared, "Ah, I can barely wait for the day when I can sell myself out to tobacco and pharmaceutical interests like a crab-infested Van Nuys crank whore!"

But the environment in which politicians continually find themselves requires constant compromise of one's values and priorities. Even the most accomplished and tenured members of the House and Senate understand that doing so is the only way to remain politically viable.

We forget - or choose to ignore - that each and every member of Congress is responsible for:

Catering to the needs and desires of his constituency

Adhering to his party's overall platform

Helping to craft policy within bipartisan committees

Not getting caught in a gay bath house with his legs wrapped around a slender Whole Foods stock clerk named Derek

And let's not forget the other seductive elements out there known for compromising politicians' personal ethics: campaign donors, pestering lobbyists, and ubiquitous interest groups. From The Washington Post:

The nation's largest insurers, hospitals and medical groups have hired more than 350 former government staff members and retired members of Congress in hopes of influencing their old bosses and colleagues, according to an analysis of lobbying disclosures and records.

Overall, health-care companies and their representatives spent more than $126 million on lobbying in the first quarter, leading all other industries, according to CRP and Senate data. PhRMA led the pack in spending and employs 49 former government staff members among its 136 lobbyists, according to The Post's analysis. Dozens of other former insiders are employed as lobbyists by Pfizer, Eli Lilly, the AMA and the American Hospital Association, each of which spent at least $3.5 million on lobbying from January through March.

So let's play make-believe. Imagine you're a fiscally-conservative, socially moderate Republican congresswoman (which, in most southern states, makes you a left-wing liberal), who believes that every American citizen should have access to affordable health care. Most likely, here's what you'd be coming up against:

Much of your party wants to altogether eliminate the public health option.

Your stone-age constituency needs complete assurance that not one cent of the package will be used for performing abortions - emergency or otherwise - stem cell research, and end-of-life consultations.

A lobbyist from a prominent pharmaceutical company - let's call them Lurk - which has promised to support your re-election bid, has just called your office to remind you of their disapproval of a public health option

The president is leaning on you and your congressional committee to keep an open mind about a substantial public component, which includes Hospice care and an additional tax on so-called platinum health plans.

At this point, whichever position you take will inevitably be ridiculed, attacked, or flat-out rejected by somebody. Ultimately, as long as you take a stand on something, there's no real way to avoid being labeled a sellout, capable of abandoning your personal ethics, your president, your crazy-assed constituency, or your party at the drop of a hat.

And that's all before the town hall meetings. Good luck with those, by the way.

But it's politically unsophisticated to think that a politician can remain ideologically pure while holding onto her job for more than one term. Politicians must compromise their ethics, on some level, every single day - and I think it's important for us to remain cognizant of that.

It's the nature of the politician's job, for better or worse. But don't feel too sorry for them. They all make six-figures, with pretty damn good bennies (which might also explain the glacial pace of health care reform); most will have cushy jobs waiting in private sector law or lobbying firms when they're finally booted from office. Some of the more high profile ones will even get book deals or will carve out a niche amongst the screaming heads on cable news.

Which brings us to our president, Mr. Hope and Change himself.

While I'm as guilty as anyone for chiding Obama's policy initiatives thus far, it's only because I naively wished for so much more. Based on his past assertions, I sincerely expected a more dogged push for universal health coverage. With, perpetually dyspeptic Rahm Emmanuel as his consigliere, a tidal wave of political capital, and strong majorities in the House and Senate, I truly expected all of us to have commie care by the 2012 at the latest.

Enter reality. The bible from his inauguration was still warm when Obama was faced with rescuing the U.S. economy from the complete and utter abyss due to 8 years of meltdowns, negligence, corruption, fiascos, and all-around suck.

Did Obama borrow Peter to pay Paul by funneling insane amounts of money into banks and automakers? Yes. Did it need to happen to prevent a nationwide economic collapse? Probably. Was it done by the most efficient, effective means possible? Well, if offering blank checks to Wall Street slime peddlers while not holding them to a much higher degree of scrutiny and transparency is effective and efficient then...yes. Is it all working, as our embattled Fed Chairman would have us believe? Maybe, but who really knows for sure at this point. Some days the economists are optimistic, some days not so much. Regardless, Wall Street's still raking us over the coals.

Still, most sane citizens are strongly averse to having their tax money earmarked for failing banks, immoral CEO's, and intransigent automakers who refused to lower their CAFE standards and to take a hint when nobody wanted a fucking mastodon on wheels anymore.

So we were forced to watch as our Obama had his wings clipped by Detroit and Wall Street.

And now, because much of his political capital has been drained by unpopular - and some say ill-advised - decisions made to save a foundering economy, the president must play ball with the opposition party, the Blue Dogs, and congressional reps from Steve and Stacy Swingstate.

He must compromise. At the very least, he must give something.

Problem is, in a civil and just society, health care is a service that shouldn't be compromised one iota - to the extent of offering ample, affordable coverage to every citizen. (This statement has been brought to you by every other developed nation on planet.) Yet it's baffling that our citizenry is still divided on this - that offering a greater breadth of coverage will somehow lead to rationing of care, a slippery slope on the way to killing Grandmas and harboring terrorists.

First of all, the private insurance companies already ration by virtue of avoiding or eliminating riskier individuals from their pools of prospective patients. They also practice the more traditional forms of rationing - you know, commie-socialist forms. From The New York Times:

And people who worry about the government's playing such a role may not remember that even now private insurers make decisions "about what is medically necessary and what is not," said Mike Thompson, a principal in the health care practice of the consulting firm Pricewaterhouse-Coopers. The private insurers, Mr. Thompson said, might decide that a certain cancer treatment was experimental, for example, and refuse to pay for it.

One can only hope that some form of rationing occurs, as rampant over-treatment has proven to be one of the biggest monetary drains on an already wildly inefficient and wasteful health care system. From The New York Times:

Paul Ginsburg, the president of the Center for Studying Health System Change, a nonpartisan research group in Washington, said he was more concerned about the opposite of rationing: that lawmakers do not seem to be focused enough on controlling costs, by making sure people do not receive unnecessary care or unproven treatments.

But if Obama continues to shy away from his previous declaration that a robust public health care option is best way to ensure true reform, then to what degree will impending legislation change the status quo - if at all?

The fallout from such a compromise could prove disastrous. If a compromise of sorts is brokered and some needed changes are made - such as cajoling health insurance companies into ending the widely used practice of rescission - without systemically revamping the entire system, who really wins? Health insurance and pharmaceutical companies will win big, as they'll garner an additional 40-50 million paying customers. And most conservative politicians will win, as they'll no doubt be hailed by the ravenous cable news punditry as the patriotic underdogs who thwarted the venomous serpent of socialized medicine. Maybe even Obama will be lauded as "post-partisan" for trading the public option (which would ultimately bury both Big Health and Pharma) for the still ambiguous co-ops, which, at best, will offer up just enough competition to the Blue Crosses of the world to make it appear as though a clean, fair game is still being played.

But what will we get out of it, other than having the privilege of overpaying for a half-assed, patchwork system that wastes resources and exploits American citizens? Maybe we won't get dropped from insurance roles when we endure a serious illness. But then we'll still have to file for medical bankruptcy upon discovery that our ailments exceed our coverage. (As I've repeated throughout many of my posts, two-thirds of all medical bankruptcies in the U.S. are filed by individuals who already had health insurance.)

And let's say a cap is established, beyond which individuals would no longer have to pay for additional care and procedures. What would that cap be? $15 thousand? $20 thousand? It's hard to imagine the insurance companies settling for less. Either way, that the we continue to haggle over the price of a person's health and well-being in this country is, to me, barbaric and morally repugnant. And as in matters of preemptive war, the environment, and torture, our nation insists on ceding the moral high ground to every other country in the world whose name doesn't end with either "bad" or "stan."

But the worst part about half-assed health care reform would be the illusion of closure and a job well done. It is both a blessing and a curse that, embedded in our nation's DNA is a need to, at some point, turn the page. In this instance, it would be a curse.

Ted Kennedy's death this week was simultaneously tragic, poignant, devastating, and ironic. Those who knew him best claim that his death comes at a time when the nation - and the health care reform movement - needs him most. Then again, pessimists might argue that his impact on such fractious negotiations would've been minimal, as his failing health would've limited him to figurehead status. For still others, Kennedy's death symbolizes the end of meaningful reform and the moral imperative of which he was such an impassioned advocate. From his August 19, 2008 speech at the Democratic National Convention:

For me, this is a season of hope. New hope for justice and fair prosperity for the many, and not just for the few. New hope - and this is the cause of my life - new hope that we will break the old gridlock and guarantee that every American - north , south, east, west, young, old - will have decent, quality healthcare as a fundamental right and not a privilege. we can meet these challenges with Barack Obama. Yes we can, and finally, yes we will.